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Capsule endoscopy feasible for monitoring Crohn’s in small intestine
Endoscopy using a wireless capsule appeared feasible for the longitudinal monitoring of Crohn’s disease in the small intestine, according to research published in Gastrointestinal Endoscopy.
Gil Y. Melmed, MD, MS, of Cedars Sinai Medical Center, and colleagues wrote that capsule endoscopy could fill a void because clinical symptom scores fail to accurately assess mucosal healing and traditional endoscopy has difficulty reaching parts of the small intestine.
“Clinical symptom scores and patient-reported outcomes do not correlate well with endoscopic assessment, thus warranting the need for endoscopic evaluation of disease activity to determine the effectiveness of any particular treatment strategy,” they wrote. “Ileocolonoscopy is considered the criterion standard for assessing disease activity; however, this assumes that the disease is within reach of conventional colonoscopy.”
Melmed and colleagues assessed the correlation between changes in capsule endoscopy score — using the Lewis score and the Capsule Endoscopy Score for CD Endoscopic Index of Severity (CECDEIS) — and several clinical scoring indices, as well as the validity and responsiveness of capsule endoscopy compared with ileocolonoscopy — using the Simple Endoscopy Score for CD (SES-CD).
Investigators included 53 patients with known CD in the trial and performed clinical evaluation with ileocolonoscopy and capsule endoscopy at baseline and at a 6-month follow-up.
While the Lewis score, CECDEIS and SES-CD did not correlate with changes in the clinical indices, Melmed and colleagues found that changes in the SES-CD scores did correlate with changes in both the Lewis score (P = .002, Spearman rank correlation = 0.48) and CECDEIS score (P < .001, Spearman rank correlation = 0.53).
Investigators also identified active inflammation proximal to the terminal ileum that was not detected through ileocolonoscopy in most of the patients. Many of those patients had not previously received a diagnosis of proximal small intestine inflammation.
Melmed and colleagues wrote that their findings reinforce past studies and position capsule endoscopy as a potential tool for the surveillance of mucosal healing in patients with CD in the small intestine.
“The lack of correlation between endoscopy and clinical disease activity scores is well established and appears to remain true for [capsule endoscopy] as it does for colonoscopy,” they wrote. “This reinforces the concept that disease activity assessments cannot rely on patient symptoms or clinical assessments alone but must include objective evaluation of the bowel in order to determine the success of a given treatment strategy using a ‘treat-to-target’ approach. This strategy, advocated in recent care pathways and expert recommendations, can help foster trust and informed decision making in a productive doctor-patient relationship.”– by Alex Young
Disclosures: The study was sponsored by Given Imaging, part of Medtronic.